Provider Demographics
NPI:1659360303
Name:ST JOHNS SURGERY CENTER LLC
Entity Type:Organization
Organization Name:ST JOHNS SURGERY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:ALBERT
Authorized Official - Last Name:QUIGLEY
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:239-466-9555
Mailing Address - Street 1:6091 S POINTE BLVD
Mailing Address - Street 2:
Mailing Address - City:FT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33919-4899
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8901 CONFERENCE DR
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33919-4895
Practice Address - Country:US
Practice Address - Phone:239-466-9555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST JOHNS SURGERY CENTER LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-10-17
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLF1238OtherPTAN